I am 37 years old taking Sustiva, Epirvir, and Zerit. My Viral has been >40 for 9 months from 7000 and CD4 unchanged at 480. Shortly after starting combo therapy 9 months ago I started feeling fatigued. Testosterone was 329ng /dl before begining IM injectiosn and I have been taking testosterone IM for ~6months with a noticable increase in energy only for the first 2months of treatment. My last lab results showed no increase in Testosterone (still ~330) after 6 months of 200mg 2x / month IM. What is maximum safe dose and IM injection frequency. I have tried weekly injections this seems to help my fatigue. I read that someone of my age 37 should be >500 ng / dl is this a correct guideline?

Response from Dr. Dieterich

Your story is not unusual, it turns out. Many men with HIV infection have low-ish levels of testosterone in the blood. There are often symptoms present, and muscle size and strength is compromised. The trouble is, it is impossible to predict just what the response will be. We observed gains in muscle (about 7 pounds of muscle, and 10 pounds total weight) after 3 months, at a dose similar to yours. This is fairly predictabe. But the effect on energy and mood is not so consistent,it seems. Many people get an initial boost in energy, then after a few months lose the effect. Some men get into an escalatng dose cycle (bigger and bigger doses, more powerful medications, etc). This too usually fails to work, as tolerance still developes.

So, you are right to receive some replacement therapy. The blood level of testosterone while on treatment is very difficult to interpret, however (because of feed-back on the boy's own production of the hormone). So it makes the most sense to decide on a desired dose, then give this, without monitoring blood levels (since these have no simple interpretation).

I recommend either IM shots of testosterone (100-150 mg per week, or 200-300 mg every other week) alone; or you might try testosterone (at 100 mg/wk or 200 mg/2 wk) combined with either oxandrolone (20 mg orally per day) or nandrolone (100 mg IM per week, or 200 mg/2 weeks). These combination regimens can be particularly effective when exercise is also being done (such as weight lifting).

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